Saturday, December 5, 2009

The value and quality of life.

I have given so much thought to the value and the quality of life as of late. What is it that makes life worth holding on to, worth living, worth sharing?

I came on shift the other day and walked into my patient’s room to immediately begin chest compressions. We shocked him 3 times and finally regained that life sustaining rhythm that we were seeking. I proceeded to work harder than I ever have over the next 12 hours to maintain that life, and at the end of my shift the heart was still beating, the vent was still forcing oxygen into the lungs, and the four overly maxed out pressors were maintaining the blood pressure. It had been touch and go all night but we maintained the patient, the patient was alive.

The truth of the matter though is that that patient will die within the near future, hours if not days. The patient will die when the family finally stops their heroic fight and lets the patient go. I question their motives. Well, maybe not their motives, maybe their understanding. The patient will never regain the quality of life that was previously employed. The patient will never be the person they were prior to these events. Maybe it is the idea of the person, the memory, and the fear of loss that continues pushing the family forward to fight so hard. I see this situation often, I know the end of this story, they don’t. I know and have seen things that are worse than death. I have seen times when it would have been much better for one to die than to continue living in the state of physical torture, pain, disfigurement, and chaos that one’s body encounters in times and places of critical care. This patient’s family has not seen these things, they do not know, they do not understand, and so they hang on to this shell of a person who once was their companion, their parent, their partner, their friend. They keep fighting for an idea that by all reasonable standards is already lost.

So what is it that gives life value? What gives life quality? Is it found in our physical beings, in our bodies ability to move about and experience life and feel and know, to walk, to live independently of aid and physical support? Is it found in our relationships, in our family and friends, in our emotional experiences and encounters? Is value found in our spirituality in knowing that we are valuable and worthy and loved because of a higher being? Is value found from within, from the pride and love we have for ourselves and our abilities, our talents, the achievement of our goals, and the amount of our successes, in the way that one feels about himself/herself?

And what is the difference in the value and the quality of life? Does one trump the other? And how can one define the value and quality of life for another? How can a family know when to keep fighting or when to quit and give up?

I don’t know all the answers to these questions. I do know my thoughts and feelings and beliefs about such matters. I also know that over time I have become calloused. I am quick to give up the fight for human life. I suppose when you watch people day after day, in extremely critical situations, lose their fight, despite insanely heroic efforts employed, you become calloused. It is rare that one will triumph, it is rare that one will overcome their stay in a critical care unit. It is even rarer that a person will live a full 12 months if they should escape their stay. And yet, in the past 3 months I have encountered 2 individuals who had critical care stays >180 days who have lived more than 2 years after their event. They were not patients of mine, they were random people I encountered who thanked me for my work, who thanked me for doing my job.

My job. My job. My job is to save lives, to work to maintain lives, to keep families together. So why do I do what I do when so rarely the outcome is the one we are fighting for, the one we are seeking?

I encounter a great deal of disgusting things: suffocating smells, grotesque sites, nightmarish situations, perpetual alarming sounds, contagious bacteria, the constant feeling of my own dirtiness absorbed from those patients. Most of the really sick ones die. No matter that I worked harder than I ever have for 12 hours, they die. They will code again and we won’t be able to again find that life sustaining rhythm. The family will come in and we will watch time and again as they crowd around the bed with wet faces and weep and cry and comfort one another, only to walk away in the end without their loved one, without my patient.

So why do I do what I do?

Because there are times, though few and far between that the patient doesn’t die. Times when that patient does walk away in the end hand in hand with the family.

Because there is great value to helping one die in peace, in comfort. It is a beautiful thing to give someone a quality death.

Because someone has to talk to the family. Someone has to explain the step by step processes and actions we are performing for their loved one. I like to be that someone. I can talk to the family and help to bridge their previous state of reality to the new one.

Because I enjoy the critical situation, I handle it well. I enjoy the adrenaline rush of the code.

Because I enjoy the critical thinking, I enjoy the troubleshooting and the employment of algorithms to treat and “heal”.

Because that is what I was made for. Because God created me to be there and do what I’m doing. I know that more than I know any other thing. I feel most alive when I am there, amid those smells and sounds and situations.

Sometimes life isn’t so cut and dry. Sometimes we work to save only to lose days later. We wonder what was the point of our efforts only to lose in the end. The point was the knowledge that we did everything we could. Despite not always understanding what gives life value or quality, we still know that it does have value and quality. We fight to maintain that. We fight to honor life. We fight to honor our patients, their families, and ourselves. There is a great deal of personal validation in fighting such a noble fight day in and day out. It is a war that will never be lost just because a battle is not won. It is a war that is reaffirmed to each of us when we each go home to our own families, when we feel little arms around our necks, when we feel old eyes look at us with pride, when we acknowledge those we love. I suppose the fight for life in others is the acknowledgement of the value and quality of our own lives. So we fight for ourselves as we fight for the patient, because we are the patient in some twisted full circle way.

Life is all encompassing.

I have given so much thought to the value and quality of life as of late.

1 comment:

holly wynne said...

I have opinions on this, but it's just concept--it's people like you who are truly on the frontline of this fight. Ultimately, I have the luxury of sitting back and saying, "I just don't know." Thank you for what you do--you don't have that luxury, and you live your life willing to embrace that same dilemma every day and make the best of it.